Provider Demographics
NPI:1083177125
Name:NGOLE, KELSEY VY (FNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:VY
Last Name:NGOLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16040 HARBOR BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1327
Mailing Address - Country:US
Mailing Address - Phone:714-531-7931
Mailing Address - Fax:
Practice Address - Street 1:16040 HARBOR BLVD STE G
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1327
Practice Address - Country:US
Practice Address - Phone:714-531-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily